Trainings

REMINDER: The rate for state-funded Personal Care service has been raised from $3.36/unit to $3.75/unit effective on October 1, 2014.

Please contact the Care Management line for any question or concerns at 1-800-893-6246 X 1902.

The Quarterly Report for Level I Incidents is due on January 10, 2014. Please send your SFY 14/15 2^nd Quarter report to IncidentReport@smokymountaincenter.com This email is also your contact for any questions you may have regarding incident reporting. Please see separate announcement regarding waiver of this requirement.

Back-Up Staffing (BUS):

1. We have noted some trends for those submitting Back-Up Staffing reports; please check the items below before submitting:

• Only one county is selected.
• Only one service is selected per incident.
• The supervisor section is completed.
• The Quality Management section is left blank.

      2.  What BUS incident report to fill out.

• Back-up staffing not available:
• This section is to be checked and completed when no staff members are available to the consumer to complete hours assigned. Example: Agreed upon staff member is sick and no other staff members are trained or available to complete the hours assigned to consumer.
• Back-up staffing offered but declined by consumer/legally responsible person (as applicable):
• This section is to be checked and completed when there is a trained back up staff person available but the consumer / guardian declines their services. Example: Agreed upon staff member is on vacation and there is other trained staff available and willing to complete the hours assigned but consumer/legally responsible person does not agree to have other staff members complete hours.

Incident Reporting

1. Level of Incident

 When completing an incident report form IRIS will choose the level of Incident. If no level of incident is picked or if you think that the level of Incident is incorrect please contact the Incident Report Team for different options. Incident.report@smokymountaincenter.com 

     2.  Attaching Documents

If an incident report is completed in IRIS as a result of a death or DSS involvement documentation must be attached. Death require a medical examiners report, autopsy, or death certificate; DSS involvement requires a letter from DSS stating either they accepted or did not accept the case. Level 3 incidents need the provider's peer review report, the preliminary findings of fact, and the final written report, in accordance with 10A NCAC 27G.0603. To attach:

1. On the left hand side of the IRIS screen under the Provider Section there is a field titled "Attach Documents"
2. Select "Attached Documents"
3. Create a Title for the document.
4. Click Browse and pick the document to be attached from your files. Highlight the file you would like to attach and click "Open".  This will place the name of the file into the locate attachment box on the IRIS screen.
5. Click Add Attachment (s) and the documents will be added to the incident report under "Attach Documents".

Smoky has identified a need in the Smoky Benefit Plan(s) for a Mental Health/Substance Abuse (MH/SA) clinical service that can be provided in a consumer's home to maximize effectiveness of care for individuals who face certain barriers to office-based therapy. Effective January 1, 2015, basic benefit 60 minute therapy (90837 + SR) will be available in both the Medicaid and State Benefit Plans at a rate of $112 for all license types. This specialized service will be made available to Medicaid and State funded consumers in all disability groups (MH/SA/IDD) who are unable to benefit from traditional office based treatment and who meet all General, Entrance, Continued Stay and Discharge Criteria as required for Outpatient Behavioral Health Services in DMA Clinical Coverage Policy 8C.

Home Based Therapy (90837 SR) requires face-to-face service delivery and may be used when a consumer's need requires outpatient level-of-care. The service is not intended to address cognitive or intellectual/developmental issues that would not benefit from outpatient therapy services.   This 60-minute psychotherapy code requires the focus of the service delivery to be on the individual; however, it can be used with the occasional involvement of family members. In addition, providers of this service must be trained in and follow a rehabilitative best practice or evidence-based treatment model consistent with community practice standards. The selected treatment model must produce positive outcome for the consumer's diagnosis and needs.

State funded consumers may access this service through Smoky's regional Comprehensive Care Centers. Smoky will continue to evaluate the need for further expansion of this service; Network Providers who would like to have this code added to their contract are encouraged to contact their Account Specialist for consideration.

In addition to meeting all Entrance, Continued Stay and Discharge Criteria found in Clinical Coverage Policy 8C the following criteria are required:

• A Comprehensive Clinical Assessment must be completed prior to the delivery of Home Based Therapy and must demonstrate necessity for Home Based Therapy to meet the consumer's treatment needs.
• The consumer cannot be safely and effectively treated in a provider's office, and reasonable attempts at office based or community based treatment are documented in the consumer's record. A failure to attempt office based or community based treatment prior to accessing this service will result in denial of authorization or recoupment. Examples of where this criteria are met include the following:
  • A consumer who is considered high risk, for example with multiple Emergency Department or after hours crisis visits, who fails to maintain/engage in routine office based treatments.
  • A consumer with a phobia or other MH/SA condition that impedes access to traditional office based therapy.
  • A consumer who has received a high level enhanced service (i.e. ACTT) for an extended period of time and who has been stabilized but who will not engage in office based treatment.
  • A child who is deemed at risk for out of home placement but does not meet other qualifiers for Intensive In Home Services. In addition, all attempts at engagement with parent or guardian have been unsuccessful.
  • A consumer with co-occurring IDD/MH diagnosis who presents with physical conditions that impede access to traditional office based treatment.
  • A consumer who requires treatment for a MH/SA condition but is unable to access office treatment due to lack of transportation. If the service is required due to a lack of transportation to attend office based treatments, all transportation alternatives, including use of public transportation, Medicaid transportation for Medicaid recipients, and natural supports must be unavailable to the recipient.
• This service can be reasonably expected to be effective in addressing the recipient's diagnosed mental health or substance use disorder.
• Without Home Based Therapy Service, there is an identified, specific, significant health and/or safety risk to the individual OR an identified, specific, significant risk of physical or mental harm to immediate family or community; or the consumer is at risk of out of home placement and/or may require a higher level of care.

Consumers who meet eligibility requirements for this specialized Home Based Therapy may receive up to 8 unmanaged visits. All applicable documentation requirements must be met for all visits, including the 8 unmanaged visits, and must demonstrate the alternatives that were accessed prior to utilizing Home Based Therapy. To request beyond the 8 unmanaged visits providers must submit a Service Authorization Request (SAR) along with the CCA. Authorization guidelines will permit up to 26 sessions for a 90 day period as medically necessary. This is viewed as a time limited service to be titrated as a consumer becomes engaged in traditional community based services.

If this service is added to your contract, any questions about authorization should be directed to the Care Management Department at 1-800-893-6246 ext. 1513. Providers with questions about contracts please contact your Account Specialist or call 866-990-9712.

• Please note: The rate change will be effective for all IIH services as of February 1, 2015 regardless of the team's ratio. 
• All other service definition requirements published Clinical Policy 8A service definition for Intensive In-Home must be met. 

If your company already uses Zixmail, you can now send securely to Smoky Mountain per your normal encryption process, and receive secure emails directly.

If you are new to Zixmail (or if your company is not currently using Zixmail) please click the following link to learn about Zixmail and how to communicate PHI to Smoky Mountain:

Thank you to all providers submitting NC TOPPS interviews! The number of delinquent interviews has declined significantly since we began sending weekly updates in July.

Top TOPPS issues

• NC TOPPS interviews are expected to be completed in-person. This allows for more accurate data collection and reporting. Performance data generated by NC TOPPS submissions influences decision-making about services on a local and State level. It is important to have complete, accurate data.
• CNDS numbers become a required field starting January 1, 2015. If your agency has a large number of state-funded consumers, please be sure you are requesting your CNDS numbers early. To obtain a CNDS number for non-Medicaid (or non-NC Health Choice) consumer, email the following information to nctopps@smokymountaincenter.com:
  • First name, middle initial, last name
  • Date of birth
  • Social
  • Language spoken
  • Ethnicity
  • Gender
  • Site address for your agency

For Medicaid and NC Health Choice consumers, the CNDS number is the Participant's Medicaid Identification number.

• The Smoky NC TOPPS superusers cannot assist with the following:
  • Claims
  • SARS
  • NC TRACKS
  • Contract issues
  • Payment issues

These issues need to be addressed by your agency's assigned Account Specialist or Claims Specialist. If you are unsure who to contact, call the provider helpline at 1-866-990-9712.  

For NC TOPPS related issues and questions, contact the Smoky NC TOPPS helpdesk at nctopps@smokymountaincenter.com.

Please see link for current 2015 NC SNAP Examiners Certification Schedule.

See link for registration information.

Rutherford County Community Forum

Smoky Mountain LME/MCO Presents The Rutherford County Community Forum Thursday, January 15, 2015 1:00-2:30PM Rutherford Community Health Services 187 Main Street-Spindale, NC

Click to learn more

Smoky Mountain LME/MCO ("Smoky") recently issued a communication about Level III Residential Services for Children and Adolescents.   In this communication, clinical expectations regarding Residential Treatment Level III services delivered concurrently with Day Treatment services were articulated.

The following is intended to provide additional information about concurrent Day Treatment and Residential Treatment Level III services. Note that these services can be reviewed together under Early Periodic Screening Diagnosis and Treatment ("EPSDT") guidelines, and will be approved anytime EPSDT criteria apply: 

• Consistent with Administrative Code (NCAC 27G .1704(e))* and Clinical Coverage policy 8D-2, Smoky views Level III residential as a comprehensive service.  
• Interventions to address behaviors occurring in the school setting that are related to the consumer's diagnosis(es), should be addressed in the PCP
• Smoky is committed to serve consumers in the least restrictive Level of Care, as indicated by accepted best practice standards
• Day Treatment is intended to serve populations for whom school interventions have been attempted and deemed insufficient - addressing consumer's barriers to education is a primary school system responsibility. As with any request for day treatment service, documented evidence that interventions by the school system have not been effective in addressing consumer's behavioral needs are required for evaluation of medical necessity.
• Per Clinical Coverage policy 8A, Day Treatment is intended to be time-limited and titrated

* "Each facility shall be responsible for ensuring supervision of children or adolescents when they are away from the facility in accordance with the child or adolescent's individual strengths and needs as specified in the treatment plan."

Please contact Care Management at 1-800-893-6246 X1910 with any questions or concerns.

In its 14^th year of fun and celebration Family Fun Day Holiday Fest is coming up on December 13, 2014. Located inside the Expo building of the WNC Ag. Center the 27,000 sq. foot space is transformed into a winter wonderland of holiday characters to meet, llamas to pet, food, face painters, balloonists and much more. A Wide variety of craft, games  and activities are provide by the service provider programs across the area. Through the wonderful efforts of multiple agencies this event is growing . Last year there were 776 people in attendance.

The event is free to all and it offers multiple ways to be involved.

1)   Provide an 'Informational Booth'.

2)   Provide an activity for attendees while promoting

       the services you offer.

3)   Be a part of the planning team for the event (meets

       monthly). Deadline for this is end of September.

4)   Off set the costs of the event by offering a financial

       or in-kind contribution.

5)   Inform families about it or just come and check it

      out yourself.

Consider how you can be  part of this really fun day, meet families and other providers of services.

For further details please contact Roxann Colwell at 828-230-3555, or email roxann.colwell@msj.org.     

See link to see how you can be involved.